JOINT SERVICES COMMITTEE 4 OCTOBER Report by Acting Director of Social Work

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1 IMR33485 JOINT SERVICES COMMITTEE 4 OCTOBER 2007 POLICY AND RESOURCES COMMITTEE 11 OCTOBER 2007 CNES HOME CARE SERVICE HOME CARE MANAGEMENT AND CONTRACTED WORKFORCE Report by Acting Director of Social Work PURPOSE OF REPORT To provide information on the outcome of the Barvas to Ness Home Care Pilot Scheme and outlines a timetable for extension of the service. COMPETENCE 1.1 There are no legal or other impediments to the recommendations in this report being considered. The financial aspects are dealt with in the body of the report. SUMMARY 2.1 The review conducted by Glasgow University on behalf of the department in 2005 identified a number of areas that should be addressed in order to meet the service needs and statutory requirements of delivering this complex and significant care service area. The essential approach to such a range of recommended actions, some with financial implications, is that they have to be prioritised for implementation in a rational way. The method of prioritising areas for action is detailed in this Report. 2.2 This Report summarises the outcomes of the Pilot Project and some financial aspects arising from them. 2.3 A key objective of this home care service review and development of its management is to improve recruitment and retention of home care staff and ensure a well trained, supported and supervised workforce which offers a high quality care service to service users, in line with legislative and regulatory requirements. 2.4 Without a stable contracted workforce, there is a risk that the Social Work Department will, in instances, be unable to staff community based care packages. 2.5 Whilst the focus of this Report is on workforce issues, the overall aim of these developments is to improve the quality of the caring experience the Social Work Department provides for service users and the level of support given to carers and their families. RECOMMENDATIONS 3.1 It is recommended that the Comhairle: a) note the outcomes of the Barvas to Ness Home Care Pilot and confirm its commitment in principle to a contracted home care workforce; and b) agree that, following reassessment of all clients, the agreement of a way ahead on meals provision and the completion of the management review of the Social Work Department, a detailed costed proposal for a contracted home care workforce will be considered in the context of setting the 2008/09 budget. Contact Officer: John Edward Tel

2 BACKGROUND HOME CARE MANAGEMENT 4.1 Detailed below are the main duties for a more effective and efficient home care service. The importance that the Comhairle has attached to having effective local management of the home care service, ensuring regular reviewing and other steps to comply consistent eligibility criteria across the service and to support financial stability; The Comhairle policy that promotes decentralisation; The phased implementation of contracts for staff employed within the service, to provide a stable, well paid and motivated workforce, but with recognition of the financial risks and costs associated with contract implementation; Developments necessary to meet the requirements for registration through the Care Commission; and The ongoing need to ensure that management arrangements are in place to address health and safety requirements to the satisfaction of the Health and Safety Executive. 4.2 The improvement in local area management would also permit more frequent service reviews and the more efficient deployment of staff, and thereby release efficiency savings. The changes are also based on meeting the requirements of the two relevant regulatory bodies the Care Commission and the Health and Safety Executive. It is also considered that quality assurance and best value practices within the Community Care Service of the Comhairle would be improved and enhanced and joint working agreements with Health and voluntary sector care providers would be improved. THE HOME CARE REVIEW SERVICE AND MANAGEMENT DEVELOPMENTS 5.1 The Home Care Review, in the section covering structures and systems, included recommendations that The separation of assessment for service from the provision of service should be confirmed, placing the home care service on a model similar to that adopted for the direct provision of the Comhairle s residential care There should be a management system for home care built around home care managers and assistants covering specific localities, with an assistant home care manager covering around 30 to 40 home carers 5.2 To place this latter recommendation in context, each Home Care Organiser in Lewis currently has responsibility for in excess of 250 clients receiving service, and each Assistant Organiser is dealing with more than 100 home care staff members. 5.3 This kind of supervisory ratio leads to the possibility of there being gaps in the quality of the home care service provided, limiting the frequency of case reviews, the direct supervision of the quality of work and support and training for the workforce. 5.4 In any setting, this ratio of supervisory staff to workers would be unusual, but it is all the more so when coupled with the fact that the workforce operates on constantly variable contracts. In any given week, in the Lewis section of the service alone, there are 100 service variations, such as change of client need, arrangement of new service, replacement arrangements for home carer sickness. These matters will be considered in the ongoing review of management structures within the Social Work Department.

3 HEALTH AND SAFETY AND CARE COMMISSION REGULATION 6.1 In addition to the intrinsic sense in establishing more effective ways of managing the home care service, for assessment and review, and for management of the workforce, there are also practical reasons from the regulatory regime under which home care increasingly operates for driving change in the service. 6.2 Earlier reviews by the Health and Safety Executive have identified improvements required in the management of the service in relation to health and safety issues. While there has been investment in safety assessment and training, in areas such as moving and handling and first aid, it is suggested that in a service that has moved to being the frontline support for many people with complex care needs, and the establishment and operation of those posts would be of considerable assistance in this regard. 6.3 The Care Commission inspection of Care at Home Services completed in September 2007 will be available to the Department in October 2007 and will be the subject of a separate report for the December series of meetings and will inform the Report referred to in recommendation 3.1(b). 6.4 The Care Commission have provided a draft report for checking factual accuracy and from this report a number of requirements and recommendations have been made in respect of the local Area Management provision of the CnES Home Care Service, including supervision and support of the workforce. The key areas considered in terms of requirement are: The Care Service will ensure access to appropriate training in adult abuse; The provider must develop a Policy and Procedure on staff training and development which must be implemented; The provider must ensure that all staff working in the service receive essential core training and that this is updated and refreshed at the required intervals; and The provider must ensure that there are current and accurate records of incidents, accidents, financial transactions and any medication administered by staff for each individual service user. CONTRACTED WORKFORCE 7.1 One of the central issues addressed in the review on the Home Care Service undertaken in 2005 was the importance of developing the workforce in ways that made it more possible to meet the growing expectation of more care, and care of a more complex nature, being provided to people in their own homes. 7.2 The case for moving from the current practice of employing home care staff on the basis that their employment is linked to the needs of their individual client group has been generally accepted, since the insecurity of employment is a major barrier to the development of a stable, well-trained and motivated workforce. 7.3 Ten home care workers in the Barvas to Ness area were recruited through a formal selection process opened up to all home care staff in that locality. This group of staff has been employed on a short term basis at salary SCP 11 on fixed-hour contracts of 28 hours. 7.4 This staff group were managed in their locality by an assistant home care service manager already in employment, who also supervised the other home care staff in that area, currently around 20, who continue to be employed under the existing variable hours traditionally applicable to the home care service. 7.5 There are currently 74 clients receiving home care service in the Barvas to Ness area and the objectives of the pilot scheme were:

4 to support employment practices that are more likely to lead to a long-term stable workforce which is trained and supported in ways that better meet the current and projected needs for care at home, to provide a more predictable and less volatile financial base for the home care service by reducing the need to vary the workforce constantly in response to individual variations in service demand, in general, to develop the home care service in ways that replicate current practice in residential and day care services, with greater stability of employment, a greater investment in staff development and training, and more clearly defined methods of providing supervision and support, and to enable the department to better deliver and sustain complex care packages which, increasingly the Home Care Service is required to provide. The majority of complex care packages now being delivered include high levels of personal care which requires the Comhairle s staff to be supervised and supported in this important and highly regarded role. OUTCOME OF PILOT PROJECT (OCTOBER 2006 TILL PRESENT) 8.1 Recruitment and retention of home carers is a key issue in relation to ensuring the sustainability of the service. If there are not enough carers, then the service cannot function, impacting on the level, quality and consistency of service for service users, informal carers and families. The main difficulties in recruiting staff are: lack of a reliable income; no fixed hours of working; working seven days per week over a number of weeks; lack of supervision and support; lack of training; isolation of workforce; amount of travelling involved means job is only really viable for those who can drive so excluding a potential pool of workers; not being paid travel time; declining and ageing population; perception of home care service as one which lights fires for old people ; the change in the service from a domestic to personal care service has left many home carers and service users feeling uncomfortable, for example with intimate personal care tasks. 8.2 The problem of recruitment and retention impacts significantly on the organisation and delivery of the Home care service with significant amount of time being spent looking for and coordinating cover. As a consequence, this creates delays and frustrations for all concerned, impacting on effective delivery of care arrangements. Adding to this difficulty is that the vast majority of home care workers on casual hours contracts meaning that the Home Care Organisers cannot require them to work additional hours even in instances where there is an urgency to cover care packages. Importantly, the current arrangements impact on service users and their families and family carers, this is particularly the situation in complex cases which can involve double carers providing a service a service up to 4 times a day 7 days a week This is not an efficient, effective use of Home Care Organisers time and means that other important activities such as case reviews and staff supervision are inadequately covered. The lack of a consistent programme of case reviews means that there is no regular assessment or an increase or decrease in needs of service users. This could mean a service being provided where it is no longer required, which is not an efficient use of limited budget resources.

5 8.3 Benefits and Contracted Arrangements for Service Users More skilled and motivated workforce; Improved quality assurance and supervision of workforce; Service user has increased confidence in carers abilities to undertake tasks e.g. personal care, medication, moving and handling; and Improved care planning and availability of information for client and allied professions. 8.4 Areas of satisfaction expressed by Contracted Home Care Staff in the Barvas to Ness Project: better communication and consultation about client needs; allocation of work is more reliable and consistent resulting in improved arrangements for service users; 7 days on 7 days off rota pattern has been well received by workers compared to their previous working patterns; now have means of identity in their role as home carer that they have been issued with uniforms with Council Logo and identity badges; are now paid for travel time between clients; fixed hour contracts and therefore have a reliable income; no longer have responsibility for finding their own holiday relief; no longer working excessive hours; guaranteed days off; improved conditions of service; and time off throughout year is now known and therefore workers can plan ahead effectively. ROLL OUT OF HOME CARE MANAGEMENT AND CONTRACTED WORKFORCE ARRANGEMENTS 9.1 The choices of approach in considering the options for taking forward a roll out programme, was first to take a narrower geographical focus and concentrate on measurable improvements that can be replicated elsewhere in later phases. The outcome of the Pilot Project Barvas to Ness clearly indicates the benefits of local management of a contracted and variable hours workforce. FINANCIAL IMPLICATIONS 10.1 To financially evaluate the pilot project from Barvas to Ness we looked at the contact time with service users, breaks and travel time paid to contracted home care workers over the initial six months of the pilot project A cost comparison was undertaken to compare the financial implications of employing contracted versus casual home care workers. This is reflected in an increased cost of approximately 20k per annum based on the eight carers employed in this period. There was a reduction in the number of paid breaks in the second quarter of the pilot scheme, when this is extrapolated for a full year it would reduce the additional cost by 4k to approximately 16k per annum The main reason for the additional costs is the paid travel time incurred between the homes of service users. Currently casually employed home care workers are only paid for the contact time with service users. From the data gathered during the pilot scheme there will be an additional cost of approximately 1.5k for each contracted worker based in a rural area, this will cost approximately 69k per annum based on existing structure staffing arrangements During the pilot scheme contracted workers were paid the first 30 minutes of down time during any time band. This condition of service will cease once the Pilot scheme concludes.

6 10.5 In light of the experience gained from the pilot, the reconciliation of hours will be conducted on a 4 monthly period instead of quarterly. This will provide the Comhairle with additional time to reduce the level of unallocated hours but also provides the care worker with a guaranteed contracted salary each month In the rollout of the scheme the contracted hours will be determined by the level of services required in the area based on current and future client needs. The time bands may also vary in each area based on the locality requirements as stipulated in the conditions of services for each worker.

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